After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers to advance their capabilities in a way that will usher in more widespread innovation. These new models encourage a shift in treatment approach that will deliver earlier interventions and better outcomes.
The following are likely trends we will see in the new year.
Value-based Incentives Impact Kidney Care in 2021
Tying revenue to volume —a fee-for-service reimbursement model — has long been the standard for treating kidney disease. This payment model has led to high hospital utilization, lack of financial accountability, and siloed care management, ultimately leading to increased costs and an uncoordinated patient journey.
To address both the high cost of care and quality of life, the Advancing American Kidney Health executive order was signed in 2019, with a goal to reduce the number of patients progressing to late-stage kidney failure and improving the cost and experience involved with ESRD care.
In September, the Centers for Medicare & Medicaid Services (CMS) released a final rule for the ESRD Treatment Choices (ETC) model, a mandatory approach impacting approximately 30 percent of kidney care providers, beginning January 1st, 2021. This model aims to bring the U.S. up to world benchmarks for both in-home dialysis and transplant rates.
Reimbursement rates will be adjusted for physicians and dialysis facilities based on home dialysis and transplant rates, first with a positive adjustment to home dialysis claims, then gradually introducing penalties.
CMS Is Paving the Way to Reduce Costs
The 2021 launch of ETC signals a broader movement by CMS to improve outcomes and reduce costs for kidney disease. In tandem, CMS took key learnings from the Comprehensive End-Stage Renal Disease Care (CEC) model and other specialties’ value-based models to develop the next value-based care iteration: Kidney Care Choices (KCC), which is led by physicians (instead of dialysis facilities) and significantly improves on prior structures. Also launching in 2021, KCC is CMS’ newest value-based kidney care model. ETC is complementary to KCC, meaning participants can be involved in both models at the same time.
KCC offers two voluntary sub-models: The Kidney Care First (KCF), a nephrologist-only model, and the Comprehensive Kidney Care Contracting (CKCC), an ACO-like model. These models will improve outcomes and reduce costs among kidney patients by slowing the progression of CKD to ESRD, increasing home dialysis, increasing transplant rate, and closing gaps in care.
KCC is centered around the nephrologist, who drives attribution into the model and acts as the quarterback for their patients’ care. The program addresses some of the historic misalignment in kidney care reimbursement by including a greater emphasis on CKD management, encouraging transplant, rewarding investment in interdisciplinary care teams, and leveling payments across dialysis modalities.
Commercial Plans will Closely Follow
Commercial payors are watching closely. Payors are increasingly adopting value-based care models intended to shift the treatment focus toward proactive and preventative care – looking to incorporate less expensive treatment options and potential remediation through transplants.
Further, there are specific actions that exacerbate cost. For example, “crash” dialysis increases costs per patient by more than $50,000 a year. Creating quality incentive bonuses that correlate with these kinds of high-cost encounters incentivizes providers to focus efforts where efficiencies can be gained.
Payors will likely follow CMS’ lead and adopt similar reimbursement structures to ETC and KCC that place an emphasis on patient management, home dialysis, and transplant. In particular, home dialysis can be a safer way to treat patients who may be at higher risk of complications from viruses, including COVID-19, and must commute to and from dialysis centers several times per week. Traveling to centers this often also can negatively impact quality of life as patients’ schedules are tied to these frequent and lengthy appointments.
As with many value-based approaches, upside-only quality measures are applied at first, encouraging physicians to beat individual or market benchmarks. These programs are expected to focus on ER visit rates, planned dialysis starts and transplantation.
New Capabilities Drive Success
Kidney care providers should make plans to adapt to these shifting trends. Success in value-based kidney care requires more preventative care, additional workstreams, and implementing technology that helps clinicians anticipate which patients are at greatest risk for chronic kidney disease (CKD), with guidance on how to optimize the treatment process.
Kidney care should emphasize early interventions to impact the primary drivers of high costs and poor outcomes. When it comes to value-based care program restructuring, these key principles are instrumental: align providers across the care continuum, become data-and technology-driven, explore new contracting models, and establish partnerships that help you succeed.
Value-based care models will have a greater impact when physicians work together toward the same quality and cost goals. Aligning efforts across the care continuum by establishing relationships and care protocols with providers such as PCPs, vascular surgeons and hospitalists is a key driver for success.
Multi-disciplinary teams work together to collectively create and implement a strategy to improve patient care, incorporating IT resources that make the approach dynamic and holistic.
Leveraging analytics delivers additional insight into a patient’s care journey, the cost and quality of referral partners, and identifies high-risk patients who would benefit from an intervention. Combining data from several sources, including claims, clinical data, live feeds from health exchanges, dialysis machines and demographic information for social determinants of health, algorithms can predict adverse events, including kidney failure during a given time frame, a cardiology event, and even mortality.
A significant amount of information is available that, when convened and put through machine learning models, can help to get the right care to the right patients at the right time. Data and technology will play a role as population health management is increasingly applied to care for chronic kidney disease patients.
Many providers feel they must build a value-based infrastructure from scratch. Nephrologists are increasingly owning their patients’ full kidney disease journey, but they do not have to own it alone. Know where you deliver your greatest value and form partnerships to supplement those skills.
Partnerships can complement a practice’s expertise and expand capabilities. The right partner will help on multiple fronts — e.g., supporting care management, creating alignment with other providers, delivering data- and technology-driven resources, and facilitating compelling value-based payor contracts. Seek care management resources, analytic vendors, financial partners, and value-based contracting experts where it makes sense.
Kidney care is about to see transformation at a higher level than has been seen in many years. By changing reimbursement strategies, a significant step is being made in matching incentives to care goals and outcomes that can open the door for further enhancements. These programs are shaping 2021 into a milestone year for kidney care.
About Chris Riopelle
Chris Riopelle is the Chief Executive Officer for Strive Health and is working to better the lives of under-served patient populations in a way that drives alignment and value for patients, providers, and payors.
– Nuance Communications, Inc. launched an AI-powered
patient engagement virtual assistant platform to transform omnichannel digital
experiences for patients.
–Healthcare provider organizations can now deploy
a single, common cloud-based platform to support their entire patient journey
across engagement channels using Nuance’s market-leading Intelligent Engagement
– The launch comes as patients increasingly expect the
same level of engaging experiences from healthcare organizations that they have
with consumer brands.
Communications, Inc., today launched an AI-powered patient
engagement virtual assistant platform to transform voice and digital
experiences across the patient journey. The platform combines Nuance’s decades
of healthcare expertise and its award-winning AI technology trusted by consumer
brands like H&M, Rakuten and Best Buy. It works by integrating and
extending Nuance’s EHR, CRM and Patient Access Center systems to enable
healthcare provider organizations to modernize their “digital front door” and
improve clinical care experiences.
Holistic Approach to Healthcare’s New Digital Front Door
Patients are demanding the same conveniences from healthcare
organizations that they enjoy from major consumer brands. A recent survey reveals that consumers are ready for
digital changes such as telemedicine options (44%), digital forms and
communication (41%), and touchless check-in (37%). What’s more, 68% value a
customized patient experience. In fact, a poor digital health experience caused
more than a quarter of patients to change medical providers in 2020 — up 40
percent from 2019.
“Our new omnichannel Patient Engagement Virtual
Assistant Platform takes a holistic approach to powering healthcare’s new
digital front door, overcoming the shortcomings and inconsistencies of partial
point solutions,” said Peter Durlach, Senior Vice President, Strategy
and New Business Development, Nuance. “By marrying the capabilities of our
healthcare experience and the proven omnichannel customer engagement technology
trusted by Fortune 100 companies worldwide, we can help address the
urgent need of providers and patients alike to transform access to, and
delivery of, care in the modern age of digital medicine.”
One of the biggest challenges for biopharmaceutical companies of rare and orphan disease patient populations is optimizing disease management in a way that enhances the patient journey and improves outcomes. As these companies seek innovative solution partners, a patient-first approach that offers specialty Rx pharmacist expertise is critical for securing insurance coverage, coordinating care, ensuring compliance, and, ultimately, minimizing the daily impact of rare and orphan diseases.
In today’s challenging healthcare environment, biopharma companies need to feel confident that their products are properly and promptly distributed, and reimbursements processed quickly and correctly. The best approach is to partner with a pharmacy, distribution, and patient management organization that offers a patient-first strategy for rare and orphan disorders, as well as personalized care programs designed to maximize the benefit of the therapies prescribed for patients. The goal is to improve the quality of life for both patient and caregiver with a dedicated support system for positive outcomes and long-term well-being.
The right patient-first partner can tailorIT, technology, and data-based upon client needs, combined with a high-touch approach designed to improve patient engagement from clinical trials to commercialization and compliance.
High Touch Meets Technology
Rare and orphan disease patients require an intense level of support and benefit from high touch service. A care team, including the program manager, care coordinator, pharmacist, nurse, and specialists, should be 100% dedicated to the disease state, patient community, and therapy. This is a critical feature to look for in a patient-first partner. The idea is to balance technology solutions with methods for addressing human needs and variability.
With a patient-first approach, wholesale distributors, specialty pharmacies, and hub service providers connect seamlessly, instead of operating in siloes. This strategy improves continuity of care, strengthens communication, yields rich data for more informed decision making, and improves the overall patient experience. It manages issues related to collecting data, maintains frequent communication with patients and their families, and ensures compliance and positive outcomes. A patient-first model also hastens time to commercialization and provides continuity of care to avoid lapses in therapy – across the entire life cycle of a product.
Key Components for Effective Patient-First Strategy
A patient-first strategy means that the specialty Rx pharmacist works directly with the patient, from initial consultation, and across the entire patient journey, providing counseling, guidance, and education-based upon individual patient needs. They also develop an individualized care plan based on specific labs and indicators related to patient behavior to help gauge the person’s level of motivation and identify adherence issues that may arise.
The best patient-first partners enable patients to contact their pharmacist 24/7 and offer annual reassessments that ensure that goals of therapy are on track and every challenge is addressed to improve the patient’s quality of life. These specialty pharmacists also play a critical role on behalf of biopharmaceutical partners, providing ongoing regulatory and operations support and addressing each company’s particular challenges.
As the COVID-19 pandemic wanes on, it’s also important to find a patient-first partner that offers a fully integrated telehealth option to provide care coordination for patients, customized care plans based on conversations with each patient, medication counseling, education on disease states, and expectations for each drug.
A customized telehealth option enables essential discussions for addressing patient challenges and needs, a drug’s impact on overall health, assessing the number of touchpoints required each month, follow-up, and staying on top of side effects.
Each touchpoint should have a care plan. For example, a product may require the pharmacist to reach out to the patient after one week to assess response to the drug from a physical and psychological perspective, asking the right questions and making necessary changes, if needed, based on the patient’s daily routine, changes in behavior and so on.
Capturing information in a standardized way ensures that every pharmacist and patient receives the same assessment based on each drug, which can be compared to overall responses. Information is gathered by an operating system and data aggregator and shared with the manufacturer, who may make alterations to the care plan based on the patient’s story.
Ideally, one phone call with a patient can begin the process of optimizing medication delivery, insurance reimbursement, compliance, and education based on a plan tailored for each patient’s specific needs.
About Dr. Brandon Salke, PHARM.D
Dr. Brandon Salke serves as the pharmacist-in-charge and General Manager at Optime Care in Earth City, MO. He previously served as a team pharmacist for Dohmen Life Science Services, where he helped launch several new care programs and assisted in the management of clinical trial activities.
He is specialized in specialty pharmaceuticals, particularly ultra-orphan, orphan, and rare disease. Dr. Salke has been involved in all aspects of operations (planning, process integration, project management, etc.) for pharmaceutical manufacturers. This includes clinical trials to commercialization and assisting in commercial launches (and relaunch) of specialty pharmaceuticals.
As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021.
Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare
Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and selectivity of these models are outperforming AI models built at a single institution, even when there is copious data to train with. As an added bonus, researchers can collaborate on AI model creation without sharing confidential patient information. Federated learning is also beneficial for building AI models for areas where data is scarce, such as for pediatrics and rare diseases.
AI-Driven Drug Discovery: The COVID-19 pandemic has put a spotlight on drug discovery, which encompasses microscopic viewing of molecules and proteins, sorting through millions of chemical structures, in-silico methods for screening, protein-ligand interactions, genomic analysis, and assimilating data from structured and unstructured sources. Drug development typically takes over 10 years, however, in the wake of COVID, pharmaceutical companies, biotechs, and researchers realize that acceleration of traditional methods is paramount. Newly created AI-powered discovery labs with GPU-accelerated instruments and AI models will expedite time to insight — creating a computing time machine.
Smart Hospitals: The need for smart hospitals has never been more urgent. Similar to the experience at home, smart speakers and smart cameras help automate and inform activities. The technology, when used in hospitals, will help scale the work of nurses on the front lines, increase operational efficiency, and provide virtual patient monitoring to predict and prevent adverse patient events.
Omri Shor, CEO of Medisafe
Healthcare policy: Expect to see more moves on prescription drug prices, either through a collaborative effort among pharma groups or through importation efforts. Pre-existing conditions will still be covered for the 135 million Americans with pre-existing conditions.
The Biden administration has made this a central element of this platform, so coverage will remain for those covered under ACA. Look for expansion or revisions of the current ACA to be proposed, but stalled in Congress, so existing law will remain largely unchanged. Early feedback indicates the Supreme Court is unlikely to strike down the law entirely, providing relief to many during a pandemic.
Brent D. Lang, Chairman & Chief Executive Officer, Vocera Communications
The safety and well-being of healthcare workers will be a top priority in 2021. While there are promising headlines about coronavirus vaccines, we can be sure that nurses, doctors, and other care team members will still be on the frontlines fighting COVID-19 for many more months. We must focus on protecting and connecting these essential workers now and beyond the pandemic.
Modernized PPE Standards Clinicians should not risk contamination to communicate with colleagues. Yet, this simple act can be risky without the right tools. To minimize exposure to infectious diseases, more hospitals will rethink personal protective equipment (PPE) and modernize standards to include hands-free communication technology. In addition to protecting people, hands-free communication can save valuable time and resources. Every time a nurse must leave an isolation room to answer a call, ask a question, or get supplies, he or she must remove PPE and don a fresh set to re-enter. With voice-controlled devices worn under PPE, the nurse can communicate without disrupting care or leaving the patient’s bedside.
Voice-controlled solutions can also help new or reassigned care team members who are unfamiliar with personnel, processes, or the location of supplies. Instead of worrying about knowing names or numbers, they can use simple voice commands to connect to the right person, group, or information quickly and safely. In addition to simplifying clinical workflows, an intelligent communication system can streamline operational efficiencies, improve triage and throughput, and increase capacity, which is all essential to hospitals seeking ways to recover from 2020 losses and accelerate growth.
Michael Byczkowski, Global Vice President, Head of Healthcare Industry at SAP,
New, targeted healthcare networks will collaborate and innovate to improve patient outcomes.
We will see many more touchpoints between different entities ranging from healthcare providers and life sciences companies to technology providers and other suppliers, fostering a sense of community within the healthcare industry. More organizations will collaborate based on existing data assets, perform analysis jointly, and begin adding innovative, data-driven software enhancements. With these networks positively influencing the efficacy of treatments while automatically managing adherence to local laws and regulations regarding data use and privacy, they are paving the way for software-defined healthcare.
Smart hospitals will create actionable insights for the entire organization out of existing data and information.
Medical records as well as operational data within a hospital will continue to be digitized and will be combined with experience data, third-party information, and data from non-traditional sources such as wearables and other Internet of Things devices. Hospitals that have embraced digital are leveraging their data to automate tasks and processes as well as enable decision support for their medical and administrative staff. In the near future, hospitals could add intelligence into their enterprise environments so they can use data to improve internal operations and reduce overhead.
Curt Medeiros, President and Chief Operating Officer of Ontrak
As health care costs continue to rise dramatically given the pandemic and its projected aftermath, I see a growing and critical sophistication in healthcare analytics taking root more broadly than ever before. Effective value-based care and network management depend on the ability of health plans and providers to understand what works, why, and where best to allocate resources to improve outcomes and lower costs. Tied to the need for better analytics, I see a tipping point approaching for finally achieving better data security and interoperability. Without the ability to securely share data, our industry is trying to solve the world’s health challenges with one hand tied behind our backs.
G. Cameron Deemer, President, DrFirst
Like many business issues, the question of whether to use single-vendor solutions or a best-of-breed approach swings back and forth in the healthcare space over time. Looking forward, the pace of technology change is likely to swing the pendulum to a new model: systems that are supplemental to the existing core platform. As healthcare IT matures, it’s often not a question of ‘can my vendor provide this?’ but ‘can my vendor provide this in the way I need it to maximize my business processes and revenues?
This will be more clear with an example: An EHR may provide a medication history function, for instance, but does it include every source of medication history available? Does it provide a medication history that is easily understood and acted upon by the provider? Does it provide a medication history that works properly with all downstream functions in the EHR? When a provider first experiences medication history during a patient encounter, it seems like magic.
After a short time, the magic fades to irritation as the incompleteness of the solution becomes more obvious. Much of the newer healthcare technologies suffer this same incompleteness. Supplementing the underlying system’s capabilities with a strongly integrated third-party system is increasingly going to be the strategy of choice for providers.
Angie Franks, CEO of Central Logic
In 2021, we will see more health systems moving towards the goal of truly operating as one system of care. The pandemic has demonstrated in the starkest terms how crucial it is for health systems to have real-time visibility into available beds, providers, transport, and scarce resources such as ventilators and drugs, so patients with COVID-19 can receive the critical care they need without delay. The importance of fully aligning as a single integrated system that seamlessly shares data and resources with a centralized, real-time view of operations is a lesson that will resonate with many health systems.
Expect in 2021 for health systems to enhance their ability to orchestrate and navigate patient transitions across their facilities and through the continuum of care, including post-acute care. Ultimately, this efficient care access across all phases of care will help healthcare organizations regain revenue lost during the historic drop in elective care in 2020 due to COVID-19.
In addition to elevating revenue capture, improving system-wide orchestration and navigation will increase health systems’ bed availability and access for incoming patients, create more time for clinicians to operate at the top of their license, and reduce system leakage. This focus on creating an ‘operating as one’ mindset will not only help health systems recover from 2020 losses, it will foster sustainable and long-term growth in 2021 and well into the future.
John Danaher, MD, President, Global Clinical Solutions, Elsevier
COVID-19 has brought renewed attention to healthcare inequities in the U.S., with the disproportionate impact on people of color and minority populations. It’s no secret that there are indicative factors, such as socioeconomic level, education and literacy levels, and physical environments, that influence a patient’s health status. Understanding these social determinants of health (SDOH) better and unlocking this data on a wider scale is critical to the future of medicine as it allows us to connect vulnerable populations with interventions and services that can help improve treatment decisions and health outcomes. In 2021, I expect the health informatics industry to take a larger interest in developing technologies that provide these kinds of in-depth population health insights.
Jay Desai, CEO and co-founder of PatientPing
2021 will see an acceleration of care coordination across the continuum fueled by the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access rule’s e-notifications Condition of Participation (CoP), which goes into effect on May 1, 2021. The CoP requires all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. Due to silos, both inside and outside of a provider’s organization, providers miss opportunities to best treat their patients simply due to lack of information on patients and their care events.
This especially impacts the most vulnerable patients, those that suffer from chronic conditions, comorbidities or mental illness, or patients with health disparities due to economic disadvantage or racial inequity. COVID-19 exacerbated the impact on these vulnerable populations. To solve for this, healthcare providers and organizations will continue to assess their care coordination strategies and expand their patient data interoperability initiatives in 2021, including becoming compliant with the e-notifications Condition of Participation.
Kuldeep Singh Rajput, CEO and founder of Biofourmis
Driven by CMS’ Acute Hospital at Home program announced in November 2020, we will begin to see more health systems delivering hospital-level care in the comfort of the patient’s home–supported by technologies such as clinical-grade wearables, remote patient monitoring, and artificial intelligence-based predictive analytics and machine learning.
A randomized controlled trial by Brigham Health published in Annals of Internal Medicine earlier this year demonstrated that when compared with usual hospital care, Home Hospital programs can reduce rehospitalizations by 70% while decreasing costs by nearly 40%. Other advantages of home hospital programs include a reduction in hospital-based staffing needs, increased capacity for those patients who do need inpatient care, decreased exposure to COVID-19 and other viruses such as influenza for patients and healthcare professionals, and improved patient and family member experience.
Jake Pyles, CEO, CipherHealth
The disappearance of the hospital monopoly will give rise to a new loyalty push
Healthcare consumerism was on the rise ahead of the pandemic, but the explosion of telehealth in 2020 has effectively eliminated the geographical constraints that moored patient populations to their local hospitals and providers. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their convenience through the growing use of consumer-grade wearable devices, patients are more incentivized in 2021 to choose the provider that works for them.
After the pandemic fades, we’ll see some retrenchment from telehealth, but it will remain a mainstream care delivery model for large swaths of the population. In fact, post-pandemic, we believe telehealth will standardize and constitute a full 30% to 40% of interactions.
That means that to compete, as well as to begin to recover lost revenue, hospitals need to go beyond offering the same virtual health convenience as their competitors – Livango and Teladoc should have been a shot across the bow for every health system in 2020. Moreover, hospitals need to become marketing organizations. Like any for-profit brand, hospitals need to devote significant resources to building loyalty but have traditionally eschewed many of the cutting-edge marketing techniques used in other industries. Engagement and personalization at every step of the patient journey will be core to those efforts.
Marc Probst, former Intermountain Health System CIO, Advisor for SR Health by Solutionreach
Healthcare will fix what it’s lacking most–communication.
Because every patient and their health is unique, when it comes to patient care, decisions need to be customized to their specific situation and environment, yet done in a timely fashion. In my two decades at one of the most innovative health systems in the U.S., communication, both across teams and with patients continuously has been less than optimal. I believe we will finally address both the interpersonal and interface communication issues that organizations have faced since the digitization of healthcare.”
Rich Miller, Chief Strategy Officer, Qgenda
2021 – The year of reforming healthcare: We’ve been looking at ways to ease healthcare burdens for patients for so long that we haven’t realized the onus we’ve put on providers in doing so. Adding to that burden, in 2020 we had to throw out all of our playbooks and become masters of being reactive. Now, it’s time to think through the lessons learned and think through how to be proactive. I believe provider-based data will allow us to reformulate our priorities and processes. By analyzing providers’ biggest pain points in real-time, we can evaporate the workflow and financial troubles that have been bothering organizations while also relieving providers of their biggest problems.”
Robert Hanscom, JD, Vice President of Risk Management and Analytics at Coverys
Data Becomes the Fix, Not the Headache for Healthcare
The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued crises in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure.
Looking to the future, it is critical to engage beyond the day to day to rise above the persistent risks that challenge safe, high-quality care on the frontline. The good news is healthcare leaders can take advantage of tools that are available to generate, package, and learn from data – and use them to motivate action.
Steve Betts, Chief of Operations and Products at Gray Matter Analytics
Analytics Divide Intensifies: Just like the digital divide is widening in society, the analytics divide will continue to intensify in healthcare. The role of data in healthcare has shifted rapidly, as the industry has wrestled with an unsustainable rate of increasing healthcare costs. The transition to value-based care means that it is now table stakes to effectively manage clinical quality measures, patient/member experience measures, provider performance measures, and much more. In 2021, as the volume of data increases and the intelligence of the models improves, the gap between the haves and have nots will significantly widen at an ever-increasing rate.
Substantial Investment in Predictive Solutions: The large health systems and payors will continue to invest tens of millions of dollars in 2021. This will go toward building predictive models to infuse intelligent “next best actions” into their workflows that will help them grow and manage the health of their patient/member populations more effectively than the small and mid-market players.
Jennifer Price, Executive Director of Data & Analytics at THREAD
The Rise of Home-based and Decentralized Clinical Trial Participation
In 2020, we saw a significant rise in home-based activities such as online shopping, virtual school classes and working from home. Out of necessity to continue important clinical research, home health services and decentralized technologies also moved into the home. In 2021, we expect to see this trend continue to accelerate, with participants receiving clinical trial treatments at home, home health care providers administering procedures and tests from the participant’s home, and telehealth virtual visits as a key approach for sites and participants to communicate. Hybrid decentralized studies that include a mix of on-site visits, home health appointments and telehealth virtual visits will become a standard option for a range of clinical trials across therapeutic areas. Technological advances and increased regulatory support will continue to enable the industry to move out of the clinic and into the home.
Doug Duskin, President of the Technology Division at Equality Health
Value-based care has been a watchword of the healthcare industry for many years now, but advancement into more sophisticated VBC models has been slower than anticipated. As we enter 2021, providers – particularly those in fee-for-service models who have struggled financially due to COVID-19 – and payers will accelerate this shift away from fee-for-service medicine and turn to technology that can facilitate and ease the transition to more risk-bearing contracts. Value-based care, which has proven to be a more stable and sustainable model throughout the pandemic, will seem much more appealing to providers that were once reluctant to enter into risk-bearing contracts. They will no longer be wondering if they should consider value-based contracting, but how best to engage.
Brian Robertson, CEO of VisiQuate
Continued digitization and integration of information assets: In 2021, this will lead to better performance outcomes and clearer, more measurable examples of “return on data, analytics, and automation.
Digitizing healthcare’s complex clinical, financial, and operational information assets: I believe that providers who are further in the digital transformation journey will make better use of their interconnected assets, and put the healthcare consumer in the center of that highly integrated universe. Healthcare consumer data will be studied, better analyzed, and better predicted to drive improved performance outcomes that benefit the patient both clinically and financially.
Some providers will have leapfrog moments: These transformations will be so significant that consumers will easily recognize that they are receiving higher value. Lower acuity telemedicine and other virtual care settings are great examples that lead to improved patient engagement, experience and satisfaction. Device connectedness and IoT will continue to mature, and better enable chronic disease management, wellness, and other healthy lifestyle habits for consumers.
Kermit S. Randa, CEO of Syntellis Performance Solutions
Healthcare CEOs and CFOs will partner closely with their CIOs on data governance and data distribution planning. With the massive impact of COVID-19 still very much in play in 2021, healthcare executives will need to make frequent data-driven – and often ad-hoc — decisions from more enterprise data streams than ever before. Syntellis research shows that healthcare executives are already laser-focused on cost reduction and optimization, with decreased attention to capital planning and strategic growth. In 2021, there will be a strong trend in healthcare organizations toward new initiatives, including clinical and quality analytics, operational budgeting, and reporting and analysis for decision support.
Dr. Calum Yacoubian, Associate Director of Healthcare Product & Strategy at Linguamatics
As payers and providers look to recover from the damage done by the pandemic, the ability to deliver value from data assets they already own will be key. The pandemic has displayed the siloed nature of healthcare data, and the difficulty in extracting vital information, particularly from unstructured data, that exists. Therefore, technologies and solutions that can normalize these data to deliver deeper and faster insights will be key to driving economic recovery. Adopting technologies such as natural language processing (NLP) will not only offer better population health management, ensuring the patients most in need are identified and triaged but will open new avenues to advance innovations in treatments and improve operational efficiencies.
Prior to the pandemic, there was already an increasing level of focus on the use of real-world data (RWD) to advance the discovery and development of new therapies and understand the efficacy of existing therapies. The disruption caused by COVID-19 has sharpened the focus on RWD as pharma looks to mitigate the effect of the virus on conventional trial recruitment and data collection. One such example of this is the use of secondary data collection from providers to build real-world cohorts which can serve as external comparator arms.
This convergence on seeking value from existing RWD potentially affords healthcare providers a powerful opportunity to engage in more clinical research and accelerate the work to develop life-saving therapies. By mobilizing the vast amount of data, they will offer pharmaceutical companies a mechanism to positively address some of the disruption caused by COVID-19. This movement is one strategy that is key to driving provider recovery in 2021.
Rose Higgins, Chief Executive Officer of HealthMyne
Precision imaging analytics technology, called radiomics, will increasingly be adopted and incorporated into drug development strategies and clinical trials management. These AI-powered analytics will enable drug developers to gain deeper insights from medical images than previously capable, driving accelerated therapy development, greater personalization of treatment, and the discovery of new biomarkers that will enhance clinical decision-making and treatment.
Dharmesh Godha, President and CTO of Advaiya
Greater adoption and creative implementation of remote healthcare will be the biggest trend for the year 2021, along with the continuous adoption of cloud-enabled digital technologies for increased workloads. Remote healthcare is a very open field. The possibilities to innovate in this area are huge. This is the time where we can see the beginning of the convergence of personal health aware IoT devices (smartwatches/ temp sensors/ BP monitors/etc.) with the advanced capabilities of the healthcare technologies available with the monitoring and intervention capabilities for the providers.
Simon Wu, Investment Director, Cathay Innovation
Healthcare Data Proves its Weight in Gold in 2021
Real-world evidence or routinely stored data from hospitals and claims, being leveraged by healthcare providers and biopharma companies along with those that can improve access to data will grow exponentially in the coming year. There are many trying to build in-house, but similar to autonomous technology, there will be a separate set of companies emerge in 2021 to provide regulated infrastructure and have their “AWS” moment.
Kyle Raffaniello, CEO of Sapphire Digital
2021 is a clear year for healthcare price transparency
Over the past year, healthcare price transparency has been a key topic for the Trump administration in an effort to lower healthcare costs for Americans. In recent months, COVID-19 has made the topic more important to patients than ever before. Starting in January, we can expect the incoming Biden administration to not only support the existing federal transparency regulations but also continue to push for more transparency and innovation within Medicare. I anticipate that healthcare price transparency will continue its momentum in 2021 as one of two Price Transparency rules takes effect and the Biden administration supports this movement.
Dennis McLaughlin VP of Omni Operations + Product at ibi
Social Determinants of Health Goes Mainstream: Understanding more about the patient and their personal environment has a hot topic the past two years. Providers and payers’ ability to inject this knowledge and insight into the clinical process has been limited. 2021 is the year it gets real. It’s not just about calling an uber anymore. The organizations that broadly factor SDOH into the servicing model especially with virtualized medicine expanding broadly will be able to more effectively reach vulnerable patients and maximize the effectiveness of care.
Joe Partlow, CTO at ReliaQuest
The biggest threat to personal privacy will be healthcare information: Researchers are rushing to pool resources and data sets to tackle the pandemic, but this new era of openness comes with concerns around privacy, ownership, and ethics. Now, you will be asked to share your medical status and contact information, not just with your doctors, but everywhere you go, from workplaces to gyms to restaurants. Your personal health information is being put in the hands of businesses that may not know how to safeguard it. In 2021, cybercriminals will capitalize on rapid U.S. telehealth adoption. Sharing this information will have major privacy implications that span beyond keeping medical data safe from cybercriminals to wider ethics issues and insurance implications.
Jimmy Nguyen, Founding President at Bitcoin Association
Blockchain solutions in the healthcare space will bring about massive improvements in two primary ways in 2021.
Firstly, blockchain applications will for the first time facilitate patients owning, managing, and even monetizing their personal health data. Today’s healthcare information systems are incredibly fragmented, with patient data from different sources – be they physicians, pharmacies, labs, or otherwise – kept in different silos, eliminating the ability to generate a holistic view of patient information and restricting healthcare providers from producing the best health outcomes.
Healthcare organizations are growing increasingly aware of the ways in which blockchain technology can be used to eliminate data silos, enable real-time access to patient information, and return control to patients for the use of their personal data – all in a highly-secure digital environment. 2021 will be the year that patient data goes blockchain.
Secondly, blockchain solutions can ensure more honesty and transparency in the development of pharmaceutical products. Clinical research data is often subject to questions of integrity or ‘hygiene’ if data is not properly recorded, or worse, is deliberately fabricated. Blockchain technology enables easy, auditable tracking of datasets generated by clinical researchers, benefitting government agencies tasked with approving drugs while producing better health outcomes for healthcare providers and patients. In 2021, I expect to see a rise in the use and uptake of applications that use public blockchain systems to incentivize greater honesty in clinical research.
Alex Lazarow, Investment Director, Cathay Innovation
The Future of US Healthcare is Transparent, Fair, Open and Consumer-Driven
In the last year, the pandemic put a spotlight on the major gaps in healthcare in the US, highlighting a broken system that is one of the most expensive and least distributed in the world. While we’ve already seen many boutique healthcare companies emerge to address issues around personalization, quality and convenience, the next few years will be focused on giving the power back to consumers, specifically with the rise of insurtechs, in fixing the transparency, affordability, and incentive issues that have plagued the private-based US healthcare system until now.
Lisa Romano, RN, Chief Nursing Officer, CipherHealth
Hospitals will need to counter the staff wellness fallout
The pandemic has placed unthinkable stress on frontline healthcare workers. Since it began, they’ve been working under conditions that are fundamentally more dangerous, with fewer resources, and in many cases under the heavy emotional burden of seeing several patients lose their battle with COVID-19. The fallout from that is already beginning – doctors and nurses are leaving the profession, or getting sick, or battling mental health struggles. Nursing programs are struggling to fill classes. As a new wave of the pandemic rolls across the country, that fallout will only increase. If they haven’t already, hospitals in 2021 will place new premiums upon staff wellness and staff health, tapping into the same type of outreach and purposeful rounding solutions they use to round on patients.
Kris Fitzgerald, CTO, NTT DATA Services
Quality metrics for health plans – like data that measures performance – was turned on its head in 2020 due to delayed procedures. In the coming year, we will see a lot of plans interpret these delayed procedures flexibly so they honor their plans without impacting providers. However, for so long, the payer’s use of data and the provider’s use of data has been disconnected. Moving forward the need for providers to have a more specific understanding of what drives the value and if the cost is reasonable for care from the payer perspective is paramount. Data will ensure that this collaboration will be enhanced and the concept of bundle payments and aligning incentives will be improved. As the data captured becomes even richer, it will help people plan and manage their care better. The addition of artificial intelligence (AI) to this data will also play a huge role in both dialog and negotiation when it comes to cost structure. This movement will lead to a spike in value-based care adoption
Industry experts state that orphan drugs will be a major trend to watch in the years ahead, accounting for almost 40% of the Food and Drug Administration approvals this year. This market has become more competitive in the past few years, increasing the potential for reduced costs and broader patient accessibility. Currently, these products are often expensive because they target specific conditions and cost on average $147,000 or more per year, making commercialization optimization particularly critical for success.
This is important because personalized medicine has the capacity to detect the onset of disease at its earliest stages, pre-empt the progression of the disease and increase the efficiency of the health care system by improving quality, accessibility, and affordability.
These factors lay the groundwork for specialty pharmaceutical companies that are developing and commercializing personalized drugs for orphan and ultra-orphan diseases to pursue productive collaboration and meaningful partnership with a specialty pharmacy, distribution, and patient management service provider. This relationship offers manufacturers a patient-first model to align with market trends and optimize the opportunity, maximize therapeutic opportunities for personalized medicines, and help to contain costs of specialty pharmacy for orphan and rare disorders. This approach leads to a more precise way of predicting the prognosis of genetic diseases, helping physicians to better determine which medical treatments and procedures will work best for each patient.
Furthermore, and of concern to specialty pharmaceutical providers, is the opportunity to leverage a patient-first strategy in streamlining patient enrollment in clinical trials. This model also maximizes interaction with patients for adherence and compliance, hastens time to commercialization, and provides continuity of care to avoid lapses in therapy — during and after clinical trials through commercialization and beyond for the whole life cycle of a product. Concurrently, the patient-first approach also provides exceptional support to caregivers, healthcare providers, and biopharma partners.
Integrating Data with Human Interaction
When it comes to personalized medicine for the rare orphan market, tailoring IT, technology, and data solutions based upon client needs—and a high-touch approach—can improve patient engagement from clinical trials to commercialization and compliance.
Rare and orphan disease patients require an intense level of support and benefit from high touch service. A care team, including the program manager, care coordinator, pharmacist, nurse, and specialists, should be 100% dedicated to the disease state, patient community, and therapy. This is a critical feature to look for when seeking a specialty pharmacy, distribution, and patient management provider. The key to effective care is to balance technology solutions with methods for addressing human needs and variability.
With a patient-first approach, wholesale distributors, specialty pharmacies, and hub service providers connect seamlessly, instead of operating independently. The continuity across the entire patient journey strengthens communication, yields rich data for more informed decision making, and improves the overall patient experience. This focus addresses all variables around collecting data while maintaining frequent communication with patients and their families to ensure compliance and positive outcomes.
As genome science becomes part of the standard of routine care, the vast amount of genetic data will allow the medicine to become more precise and more personal. In fact, the growing understanding of how large sets of genes may contribute to disease helps to identify patients at risk from common diseases like diabetes, heart conditions, and cancer. In turn, this enables doctors to personalize their therapy decisions and allows individuals to better calculate their risks and potentially take pre-emptive action.
What’s more, the increase in other forms of data about individuals—such as molecular information from medical tests, electronic health records, or digital data recorded by sensors—makes it possible to more easily capture a wealth of personal health information, as does the rise of artificial intelligence and cloud computing to analyze this data.
Telehealth in the Age of Pandemics
During the COVID-19 pandemic, and beyond, it has become imperative that any specialty pharmacy, distribution, and patient management provider must offer a fully integrated telehealth option to provide care coordination for patients, customized care plans based on conversations with each patient, medication counseling, education on disease states and expectations for each drug.
A customized telehealth option enables essential discussions for understanding patient needs, a drug’s impact on overall health, assessing the number of touchpoints required each month, follow-up, and staying on top of side effects.
Each touchpoint has a care plan. For instance, a product may require the pharmacist to reach out to the patient after one week to assess response to the drug from a physical and psychological perspective, asking the right questions and making necessary changes, if needed, based on the patient’s daily routine, changes in behavior and so on.
This approach captures relevant information in a standardized way so that every pharmacist and patient is receiving the same assessment based on each drug, which can be compared to overall responses. Information is gathered by an operating system and data aggregator and shared with the manufacturer, who may make alterations to the care plan based on the story of the patient journey created for them.
Just as important, patients know that help is a phone call away and trust the information and guidance that pharmacists provide.
About Donovan Quill, President and CEO, Optime Care
Donovan Quill is the President and CEO of Optime Care, a nationally recognized pharmacy, distribution, and patient management organization that creates the trusted path to a fulfilled life for patients with rare and orphan disorders. Donovan entered the world of healthcare after a successful coaching career and teaching at the collegiate level. His personal mission was to help patients who suffer from an orphan disorder that has affected his entire family (Alpha-1 Antitrypsin Deficiency). Donovan became a Patient Advocate for Centric Health Resources and traveled the country raising awareness, improving detection, and providing education to patients and healthcare providers.
– Innovaccer partners with SyTrue to uncover powerful insights
and accelerate its efforts to drive healthcare’s digital transformation.
– The integration of SyTrue’s proprietary NLP OS with
Innovaccer’s FHIR-enabled Data Activation Platform will empower healthcare
organizations to identify diagnosis codes and Hierarchical Condition Categories
(HCC) from patient care progress notes and other unstructured texts.
Innovaccer, Inc., a San
Francisco, CA-based healthcare
technology company, announces its partnership with SyTrue, a leading provider of clinical data
extraction, to generate robust, actionable insights from healthcare data. The
partnership allows Innovaccer to leverage healthcare’s most-advanced Natural
Language Processing Operating System, NLP OSTM, and dive deep into clinical
data, extracting valuable details about patient health journeys.
Empowering Healthcare Organizations to Improve Patient
The integration of SyTrue’s proprietary NLP OS with
Innovaccer’s FHIR-enabled Data Activation Platform will empower healthcare
organizations to identify diagnosis codes and Hierarchical Condition Categories
(HCC) from patient care progress notes and other unstructured texts. With the
ability to gain insights from the unstructured datasets, providers can improve
the accuracy of patient risk scores.
SyTrue’s NLP OS will empower Innovaccer’s data platform to
semantically search, identify, and discover key elements from medical records
across the organization, delivering relevant, actionable insights at the moment
of care. NLP OS will allow Innovaccer to help its clients extract details about
lab records, medications, vital signs, diagnoses, and other elements from
structured and unstructured sources to successfully meet quality requirements.
The partnership will allow Innovaccer’s customer provider organizations to understand their patients’ medical records in a more comprehensive manner and optimize reimbursement through advanced coding, smart cohort identification, and unstructured data normalization.
“Creating a longitudinal record is paramount to enabling an intelligent journey throughout our complex healthcare system. Too often, crucial patient data is not included as part of the complete medical record because it is locked in faxes, portable document formats (PDFs) and other unstructured documentation. To unlock the insights contained within these files is expensive and time-consuming,” says Kyle Silvestro, CEO at SyTrue. “Our partnership with Innovaccer will reduce the time and cost to create intelligent and comprehensive insights which will significantly enhance the patient journey.”
COVID-19 terms such as quarantine, flatten the curve, social distance, and personal protective equipment (PPE) have dominated headlines in recent months, but what hasn’t been discussed in length are the hidden costs of COVID-19 as it relates to patient adherence.
The coronavirus pandemic has amplified this long-standing issue in healthcare as patients are delaying routine preventative and ongoing care for ailments such as mental health and chronic disease. Emergency care is also suffering at alarming rates. Studies show a 42 percent decline in emergency department visits, measuring the volume of 2.1 million visits per week between March and April 2019 to 1.2 million visits per week between March and April 2020. Patients are not seeking the treatment they need – and at what cost?
When the SARS outbreak occurred in 2002, particularly in Taiwan, there was a marked reduction in inpatient care and utilization as well as ambulatory care. Chronic-care hospitalizations for long-term conditions like diabetes plummeted during the SARS crisis but skyrocketed afterward. Similar to the 2002 epidemic, people are currently not venturing en masse to emergency rooms or hospitals, but if history repeats itself, hospital and ER visits will happen at an influx and create a new strain on the healthcare system.
So, if patients aren’t going to the ER or visiting their doctors regularly, where have they gone? They are staying at home. According to reports from the Kaiser Family Foundation, 28 percent of Americans polled said they or a family member delayed medical care due to the pandemic, and 11 percent indicated that their condition worsened as a result of the delayed care. Of note, 70 percent of consumers are concerned or very concerned about contracting COVID-19 when visiting healthcare facilities to receive care unrelated to the virus. There is a growing concern that patients will either see a relapse in their illness or will experience new complications when the pandemic subsides.
Rather than brace for a tidal wave of patients, healthcare systems should proactively take steps (or act now) to drive patient access, action, and adherence.
1. Identify Who Needs to Care The Most
Healthcare providers should consider risk stratifying patients. High-risk people, such as an 80-year-old male with comorbidities and recent cardiac bypass surgery, may require a hands-on and frequent outreach effort. A 20-year-old female, however, who comes in annually for her physical but is healthy, may not require that level of engagement. Understanding which patients are at risk for the potential for chronic conditions to become acute or patients who have a hard time staying on their care plan may need prioritized attention and a more thorough engagement effort.
For example, patients with a history of mental health issues may lack motivation or momentum to seek care. Their disposition to be disengaged may require greater input to push past their disengagement.
Especially important is the ability to educate and guide patients to the appropriate venue of care (ER, telehealth visit, in-person primary care visit, or urgent care) based on their self-reported symptoms. Allowing patients to self-triage while scheduling appointments helps them make more informed decisions about their care while reducing the burden on over-utilized emergency departments.
2. Capture The Attention of The Intended Audience and Induce Action
Once you’ve identified who needs care the most, how do you break through the “information clutter” to ensure healthcare messages resonate with the intended audience? The more data points, the better. It is important to understand the age of the patient, their preferred communication channel, and the intended message for the recipient, but effective communication exceeds those three data points. Consider factors like the presence of mental health conditions, comorbidities, or health literacies. Then, think beyond the patient’s channel of choice and select the appropriate channel of communication (text, phone call, email, paid social media advertisement, etc.), that will most likely induce action. As an organization, also consider running A/B tests to detect and analyze behavior. As you collect more data, determine what exactly is inducing patient action.
Of note, don’t underestimate the power of repetition. Patients may need to be reminded of the intended action a few times in a few different ways before moving forward with seeking the care they need. Repetition is also shown to decrease no-show rates, a critical metric. Proactive, prescriptive, and tailored communication will help increase engagement. Moving past the channel of choice and toward the channel of action is key.
3. Engage Patients Through Personalized and Tailored Communication
In addition to identifying the right communication channel, it’s also important to ensure you deliver an effective message. Communication with patients should be relevant to their particular medical needs while paying close attention to where each person is in their healthcare journey. Connecting with patients on both an emotional and rational level is also important. For example, sending a positive communication via phone, email, or text to lay the foundation for the interaction shows interest in the patient’s wellbeing.
A “Hey, here’s why you need to come in” note makes a connection in a direct and personalized way. At the same time, and in a very pointed manner, sharing ways providers and health systems are keeping patients safe (e.g., telehealth, virtual waiting rooms, separate entrances, and mandating masks), also provides comfort to skittish patients. Additionally, consider all demographic information when tailoring communications. And don’t forget to analyze if changes in content impact no-show rates. Low overall literacy may impact health literacy and may require simpler and more positive words to positively impact adherence.
It may sound daunting, especially for individual health systems, to personalize patient communication efforts, but the use of today’s data tools and technological advancements can relieve the burden and streamline efforts for an effective communication approach.
4. Use Technology to Your Advantage (With Caution)
Once you have developed your communication strategy, don’t stop there. Consider all aspects of the patient journey to drive action. A virtual waiting room strategy, for example, can help ease patient concerns and encourage them to resume their care. Health systems can help patients make reservations, space out their arrival times, and safeguard social distancing measures—all while alleviating patient fears. Ideally, the patient would be able to seamlessly book an appointment and receive a specific arrival time, allowing ER staff to prepare for the patient’s arrival while minimizing onsite wait time.
When implemented properly, telehealth visits can also improve continuity of care, enhance provider efficiency, attract and retain patients who are seeking convenience, as well as appeal to those who would prefer not to travel to their healthcare facility for their visit. Providers need to determine which appointments can successfully be resolved virtually. Additionally, some patients might not have the means for a successful telehealth visit due to a lack of internet access, a language barrier, or a safe space to talk freely.
To ensure all patients receive quality care, health systems should make plans to serve patients who lack the technology or bandwidth to participate in video visits in an alternative manner. For example, monitor patients remotely by asking them to self-report basic information such as blood sugar levels, weight, and medication compliance via short message service (SMS). This gives providers the ability to continuously monitor their patients while enhancing patient safety, increasing positive outcomes, and enabling real-time escalation whenever clinical intervention is needed.
It is important we ensure all patients stay on track with their health, despite uncertain and fearful times. Health systems can enhance patient adherence and induce action through the implementation of tools that increase patient engagement and alleviate the impending strain on the healthcare system.
About Matt Dickson
Matt Dickson is Vice President of Product, Strategy, and General Manager of Stericycle Communication Solutions, a patient engagement platform that seamlessly combines both voice and digital channels to provide the modern experience healthcare consumers want while solving complex challenges to patient access, action, and adherence. . He is a versatile leader with strong operational management experience and expertise providing IT, product, and process solutions in the healthcare industry for nearly 25 years. Find him on LinkedIn.
Abbott recently released global research on vascular patient care, designed to shine a light on the vascular patient journey. The report called “Beyond Intervention” uncovers the universal challenges faced by physicians who deliver vascular care, their patients, and the hospital administrators who support them. It also explores how the right use of technology and data could potentially enable more precise diagnoses and better treatment strategies to ensure the best possible patient outcomes.
To establish what the state of vascular care looks like around the world today, Abbott surveyed over 1,400 patients, physicians, and health system administrators from nine countries.
The research revealed how important personalized care is for patients. This was a sentiment that came through loud and clear from all the patients surveyed, regardless of geography. Patients desire more of a “tailored for me” approach from their physicians. This includes more face-to-face interaction and time with their doctor, with the ability to have all of their questions addressed.
Likewise, doctors sighted a scarcity of time spent with their patients as well as their limited visibility into patient adherence to treatment and lifestyle changes and challenges with other key factors that influence the quality of care they can provide.
What exactly does more personalized care look like? Here are some of the ideas that resonated with the vascular patients who responded to the survey:
– A consultative, two-way patient-doctor relationship, with the patient playing an active role in informed decision-making
– An individualized treatment plan based on the doctor’s ability to review relevant data pertaining to successes achieved with similar patients (“How did patients like me get better?”)
– Effective and seamless information-sharing among the primary care provider, hospital specialists, and healthcare systems, as well as with individual patients themselves via computer or smart applications.
– The ability for the doctor to monitor the patient’s progress remotely and provide information to verify that the personalized treatment is working, and to pick up early warning signs of relapse or deterioration
If more personalized care is what patients desire, then how can the use of technology and data enable this? We already see signs of this in the form of telemedicine and personalized care plans used to treat patients with chronic disease. We have also seen remote patient monitoring become a necessity and, in the age of COVID-19, a new standard of care, keeping patients “connected” with their physicians. This suggests that health care is moving in the right direction. Rather than simply treating the patient at a point in time for an illness, technology has the potential to harness the power of data to optimize care across the entire patient journey – before, during, and after the intervention. By focusing on the whole patient, and by placing him or her at the center of the healthcare world, providers can see beyond the intervention alone.
The survey also revealed that hospital administrators’ top priority focused on patient satisfaction; successful outcomes that boost the number of satisfied and healthy patients while reducing hospital readmissions and costs. The results showed that administrators place a greater priority on plugging data gaps pertaining to outcomes than the total cost of care.
If the intention is to build data-driven technological solutions that see the whole patient, that could shift the focus from illness and intervention to wellness and prevention, potentially lightening the burden on providers, and delivering a higher quality of life for patients, also at a lower cost.
The existing model of care is clearly not working to its full potential, to the detriment of everyone who must navigate it. But overhauling a healthcare system that is so entrenched in structure and institutional practices is not something that can happen overnight. Change will happen incrementally with the input of all stakeholders. It is up to us in the world of medical devices and technology to take our cues from the medical community, patient advocates, and healthcare systems big and small.
The research motivates us to continuously improve upon what we have already delivered and ask ourselves how we can make our products even better. Without knowledge of their pain points or insights into the challenges they face daily, we would not be able to effectively meet patients’ needs. This research also reinforces what Abbott is consistently striving to achieve: building life-changing technologies to improve the patient’s quality of life and help them live their best lives.
– Cohere Health partners with health insurer Humana to modernize
the prior authorization process for musculoskeletal treatment across 12 states.
– In addition, the company has closed an additional $10M
in funding led by Flare Capital Partners and Define Venture, bringing the
company’s total funding to $20M.
Health insurer Humana has signed an agreement with healthcare collaboration company Cohere Health to improve the prior authorization process for musculoskeletal treatment across 12 states, starting Jan. 1, 2021. Cohere aligns physicians, patients, and health plans on a patient’s optimal healthcare experience—enabling access to higher quality care while at the same time minimizing administrative burden and siloed decision-making.
The partnership leverages CohereNext Platform’s prior authorization capability which grants authorizations across an entire episode of care, in effect pre-authorizing a complete treatment regimen from the initial diagnosis to treatment plan selection, and, ultimately, to the patient’s return to good health. Cohere’s approach aims to expedite evidence-based treatment plans to improve the healthcare experience for doctors and patients alike.
Humana to Leverage CohereNext Platform to Streamline
As part of the partnership, Humana will employ the CohereNext Platform to streamline prior authorizations in musculoskeletal treatment in Alabama, Georgia, Indiana, Kentucky, Michigan, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. The platform will initially serve approximately 2 million members and more than 3,500 physician practices.
This partnership supports Humana’s vision to reimagine and modernize processes for prior authorization by reducing approval times and improving the delivery of care, all while preserving important benefits such as safety, predictability, and cost containment.
Cohere’s solution will initially focus on prior
authorization; the company is developing additional use cases such as
value-based contract performance, improving physician and patient engagement,
and optimizing health plan clinical programs. By facilitating physician and
health plan collaboration, Cohere’s technology will help accelerate the
evolution to value-based care models.
“Through this strategic initiative and collaboration with Cohere Health, Humana is building on its commitment to reduce the complexity and friction of prior authorization for our physicians and members,” said William Shrank, MD, MSHS, Chief Medical Officer, Humana and Board Member, Cohere Health. “Cohere’s solution was co-designed with physicians and represents a major leap forward in improved physician experience and the adoption of evidence-based medicine.”
Cohere Health Closes Additional $10 Million in Funding to
Accelerate Delivery of Patient Journey Platform
In addition, the company announced it closed an additional
$10 million in funding led by Flare
Capital Partners and Define Ventures,
bringing the company’s total funding to $20 million. The funding will be used
to enhance the company’s scalable CohereNext® platform that is built on
next-generation cloud and data technologies and provides interoperability to
existing healthcare infrastructure as well as the emerging digital health
Series A extension comes just two months after Cohere Health’s initial $10 million Series
A funding, which was also led by Flare
Capital Partners with Define Ventures contributing as an investor and partner,
as well as participation from a leading national strategic partner.
The CohereNext Platform improves the physician experience
and quality by:
– Authorizations that begin with diagnoses and not billing
– Facilitating and auto-approving evidence-based treatment plans
– Delivering a peer review process with a true peer
specialist or sub-specialist
– Sharing quality performance relative to peers for specific
care paths and patient cohorts
– Providing tools, data and technology that optimizes
“The tragedy of COVID-19 has reinforced that the basic infrastructure supporting healthcare innovation is fundamentally broken. The shift from fee-for-service to value-based-care requires enabling interoperable capabilities to facilitate care around the interests of patients, and as a result, Cohere Health continues to rapidly grow and attract additional investments,” said Siva Namasivayam, CEO and founder of Cohere Health. “The additional funding will enable us to expand the CohereNext platform to impact more failure points across patient journeys so that physicians can deliver better outcomes and we can continue building our team, which has grown by more than 95 people this year.”
– AI-driven virtual care company, GYANT, has announced its first-to-market COVID-19 vaccine care navigation tool to help health systems anticipate novel patient needs.
– GYANT Vaccine deploys as a white-labeled virtual
assistant on provider websites, mobile apps, and patient portals, managing the
patient journey from initial inquiry to post-visit follow up.
GYANT, the AI-powered
virtual assistant company, today announced its first-to-market vaccine care
navigation tool, GYANT Vaccine,
anticipating impending health system strain following emergency use
authorization of a COVID-19
vaccine. The solution offers support for each step of the patient journey, from
initial inquiry to post-vaccination follow-up.
GYANT Vaccine builds on the company’s successful COVID-19
SERA technology, which rapidly helped 25 payer and health system customers and
half a million patients screen and triage symptoms to access testing and care.
With the addition of Vaccine, GYANT’s AI-powered virtual assistant platform now
even more effectively connects the dots across patients’ digital journeys with
the existing Front Door (care navigation and triage), Engage (patient outreach)
and Clipboard (automated chart population) modules.
Is Your Health System Prepared for the Vaccine?
Anticipating the tsunami of inbound patient inquiries,
overwhelmed call centers, appointment scheduling demands, and eligibility
screening requests as the vaccine becomes available, GYANT Vaccine will
virtually guide patients through the entire pre- and post-vaccination process
GYANT Vaccine deploys as a white-labeled virtual assistant
on provider websites, mobile apps, and patient portals, managing the patient
journey from initial inquiry to post-visit follow up. GYANT Vaccine is
available 24/7, to relieve the burden of administrative staff, simplify the
research and appointment scheduling for consumers, and keep patients safe.
By empowering patients to learn about processes and options,
screen and assess prioritization, book appointments, and stay in touch with
their providers to schedule additional doses and monitor for side effects,
GYANT Vaccine adapts to each provider’s changing requirements over the course
of the vaccine roll-out.
“Navigating the deployment of the COVID-19 vaccine will be the single biggest challenge healthcare systems face in 2021,” said Stefan Behrens, co-founder and chief executive officer, GYANT. “With our help, customers are poised to effectively anticipate and manage the vaccine’s deployment whenever it is approved, and play a role in controlled widespread adoption as we seek to overcome this crisis.”
GYANT Vaccine has already generated overwhelming interest in
the market with five health systems signed on to deploy the tool following
emergency use authorization of a vaccine.
– Nationwide disease registry Corrona has acquired
virtual patient community HealthUnlocked, creating a first-in-class patient
– The acquisition will enable Corrona to expand its broad
set of capabilities–ranging from highly granular and longitudinal structured
data across eight registries.
(“Corrona”), a nationwide disease registry and is now the largest
registry in the world collecting data on Rheumatoid Arthritis (RA), today
announced it has acquired
London-based HealthUnlocked, the
world’s largest virtual patient community.
Acquisition Will Establish Innovative Snapshot of Patient
Founded in 2010, HealthUnlocked leverages an innovative
social platform to connect 1.3 million patients, representing over 300 disease
states and conditions with more than 500 patient advocacy groups. Corrona’s
investment in HealthUnlocked helps to further expand the patient engagement
offerings that began in late 2019 with Corrona’s acquisition of HealthiVibe, a recognized leader in
patient experience and engagement. HealthUnlocked provides an additional
dimension of cultivated data by leveraging a social network of 1.3 million
patients across hundreds of condition-specific communities, moderated by over
500 patient advocacy groups, capturing insights to better understand what
matters most to these patients. HealthUnlocked will be integrated into
Corrona’s HealthiVibe business unit to establish an innovative and holistic
snapshot of the patient.
By building out its patient experience business, Corrona is working to create an industry-leading ecosystem centered around the patient voice. This ecosystem directly supports both the 21st Century Cures Act and the FDA’s Patient-Focused Drug Development initiative, and establishes Corrona as a leader in patient insights and real-world evidence with both a scalable technology platform and short- and long-term outcomes and safety data. This data powerhouse is the first of its kind to provide such a wholistic, 360⁰ degree view of a patient while ensuring data integrity.
“By combining with HealthUnlocked, we are expanding our broad set of capabilities–ranging from highly granular and longitudinal structured data across our eight registries, to broader patient insights from HealthUnlocked,” said Abbe Steel, Chief Patient Officer of Corrona. She continued, “The HealthUnlocked communities provide access to engaged patients across the globe, allowing us to better understand the patient experience and what matters most to patients. Our organization is positioned to expand its expertise in gathering, analyzing, and applying deep patient insights to optimize the patient journey and bring significant value to our clients.”
With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries. A recent survey found that more than 80% of consumers surveyed believe “shopping for healthcare should be as easy as shopping for other common services.” Specifically, they want streamlined access points online where they can shop for and purchase healthcare, easily make appointments, understand what they need to pay, make payments, and set up payment plans – or even obtain financing for care if the estimated costs exceed their budgets.
These types of digital experiences help providers recruit new patients and keep them engaged, which leads to better outcomes for both the health of the patient and the financial health of the practice. Unfortunately, most healthcare organizations aren’t ready to provide this level of convenience. In part, this is because they have relied on patient portals as their main digital engagement tool to date.
The problem with portals
There are a few reasons why patient portals underdeliver. First, portals are only for patients that have an existing relationship with a provider. However, the patient experience begins when consumers start shopping for care. Relying on a portal alone is a missed opportunity to generate new patient business.
Second, portals don’t mirror what consumers expect from digital solutions. The interfaces are clunky, the functionality is limited, and the technology only supports a pull strategy, meaning that it waits for the patient to come to it rather than periodically reaching out and prompting the individual to take action.
Third, a patient must be logged into a portal before they can do anything with it. This makes it harder to schedule appointments with new physicians because there is not an established connection. In these cases, the patient must pick up the phone, wait on hold, set up an account, possibly wade through insurance approval and pre-authorization, and then make the appointment.
Finally, portals aren’t ideal for communicating costs. While some allow the patient to pay co-pays, they aren’t designed to give realistic cost estimates, offer payment plans, suggest alternative funding sources, and so on.
Taken together, these challenges result in low, inconsistent portal use. Even if a hospital indicates that 50% of its patients access the portal, one-time or limited use should not be viewed as patient engagement. Instead, to realize true engagement, organizations should be thinking about ways to foster two-way conversations to keep new and existing patients focused on their health and how the hospital, health system, or physician practice can meet their needs. This improves patients’ experience and builds loyalty, while also reducing leakage and growing revenue.
What are the risks of poor digital engagement?
Without a well-considered plan for providing a retail-like shopping experience that includes transparent cost information, healthcare organizations run the risk of losing patients. This is especially important as the marketplace becomes more competitive and focused on patient experience, and retail clinics continue to pop-up around the country.
In addition to market changes, regulatory pressures are also making patient-centric financial communications a necessity. Several states are implementing price transparency regulations, and a federal requirement is right around the corner. To meet these standards, organizations will need effective tools that reliably determine and share prices with patients in advance of their appointments.
So where do organizations go from here?
It’s clear that patient portals are not the answer. But how can organizations do a better job of giving patients the convenience they seek? Here are four best practices to consider.
1. Evaluate your organization’s digital tools.
The first step is to take a hard look at the digital solutions you currently provide and compare them to those available from other industries, such as travel, retail, and financial services. Consumers want a digital, retail-like shopping experience where they can search local providers, compare reviews and costs, schedule their treatment, and even pay – all in one intuitive place.
Don’t be fooled into thinking that only younger people want these tools. Research shows that more and more older adults are embracing mobile activities like online banking. In fact, The Harris Poll found that 80% of Baby Boomers (individuals between 56-76 years old) “wish there was a single place to shop for and purchase care.”
Digital tools designed to improve access and transparency while making it easier to pay create more engaged consumers and provide a better patient experience. Achieving this dual dynamic requires digital tools are part of a comprehensive end-to-end solution.
2. Streamline access to shoppable services
These are elective procedures and screening tests that an individual can schedule in advance and include things like planned joint replacements, colonoscopies, and mammograms. Healthcare organizations offer standardized pricing for these services, allowing patients to shop around for the best price, location, and experience.
When patients are able to use a digital tool to research a service, set an appointment, and make a payment, it can drive patient satisfaction and increase the chances the individual will choose to have the procedure with the organization supplying the tool. With 67% of consumers stating they would “shop for healthcare entirely online, like any other products and services,” streamlining access to shoppable services will drive engagement and revenue.
3. Adopt tools that help people understand their care costs.
More than half of consumers surveyed for The Harris Poll said they have “avoided seeking care because they weren’t sure what the price would be.” The biggest hurdle to accessing care is price transparency, resulting in patients not getting the treatment they need and in poor revenue management for a practice.
Patients are more likely to pay their portion up front when they understand what they owe and feel confident that the cost information provided has taken into consideration their current insurance, deductibles, and co-pays. A key to accurate estimates is an automated solution that checks the patient’s insurance digitally, determines the benefits, reviews the amount of any deductible, and verifies whether the individual has already met their deductible. When a patient financial tool also offers the ability to make payments or set up a payment plan, it can increase patients’ propensity to pay, boost the amount of self-pay funds the organization collects, and substantially reduce the cost-to-collect.
4. Enable digital appointment scheduling
Consumers view scheduling and rescheduling appointments as a very difficult task. Digital solutions can address this pain point. Mobile tools and apps that patients can use to schedule appointments monitor wait times, digitally complete forms, and check-in for appointments are essential to breaking down some of the barriers to patient access.
Before onboarding a tool like this, organizations must think through the change management challenges in getting all stakeholders on board. Historically, physicians have been hesitant to open up their calendars to permit digital scheduling. However, transparency and standardization are becoming increasingly important to meet patient demand and are necessary to make these types of tools work smoothly.
Although digital tools are gaining popularity among all generations, there are still people who prefer to pick up the phone to price, schedule, and pay for care. In addition to digital solutions, organizations should have service-oriented call centers to work with these patients. Such centers should have well-trained professionals who are available during and outside of traditional business hours so patients can access the information they need when they need it.
Relying on the status quo is not wise
Healthcare is only going to become more consumer-driven as high-deductible health plans continue to disrupt the industry. Hospitals, health systems, and physician practices cannot afford to rely on outdated technologies that don’t facilitate two-way conversations or the digital experience patients expect. To compete today and in the future, organizations need a comprehensive, retail-like solution that offers a seamless user experience and spans the entire patient journey. Tools and technologies used in combination with putting the patient first will build loyalty while also improving an organization’s clinical and financial outcomes.
About Bill Krause
Bill Krause is the Vice President of Experience Solutions at Change Healthcare. Serving the healthcare industry for over 12 years, Bill leads innovation and solution development for patient experience management at Change Healthcare. In this role, he is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities.
Previously, Bill provided insights and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships, and corporate development across a variety of healthcare services and technology lines of business for those companies.
Prior to McKesson, Bill worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries. He received his MBA from Harvard Business School and his undergraduate degree from the University of Virginia. He also served as a lieutenant in the United States Navy.
The COVID-19 pandemic has caused an unprecedented shift in the way consumers view and access a variety of goods and services—and healthcare is no exception. Recent studies show that many patients, including vulnerable populations like those living with cancer, are delaying recommended care and procedures—and will continue to do so for at least several months amid fears over the safety of in-person visits. In response, reports of providers adapting to offer care virtually are all the more commonplace, with almost half of physicians now treating patients through telemedicine platforms, up from just 18 percent in 2018.
These trends have solidified virtual care as a mainstay, and as a result, the virtual visit has become a commodity—a service that can be provided by many capable vendors. However, the logistics that power the adoption of virtual care are often overlooked. As healthcare administrators turn to telemedicine to resume “non-urgent” healthcare services, we must ensure that best-in-class technology solutions are utilized to improve the virtual care experience—for providers, clinical staff, and, importantly, patients.
Health systems and their networks face significant operational issues when delivering care in a remote setting, due to the range of potential interactions and diversity of devices—adding to the already recognized administrative burden that comes with routine patient care. With each patient visit comes over a dozen manual tasks, including patient intake and registration, in-visit clinical note writing, as well as back-office billing and claims processing. The virtual visit adds even more steps, such as helping patients access the appropriate technology for a two-way video interface or sending custom links to a “virtual waiting room” at the right time.
Facilitating a seamless virtual care experience before, during, and after a patient’s visit should be top-of-mind—particularly as patient expectations have heightened and healthcare has progressed towards a technology-enabled future. Fortunately, the automation of operational workflows can help healthcare administrators smooth the friction around conducting virtual visits at scale.
Intelligent automation extends our capacity in healthcare by enabling us to do more with the same workforce and technology infrastructure. In fact, digital medical assistants can use artificial intelligence to automate repetitive, cognitively tiring, and error-prone tasks. This technology can support the influx of virtual visits by offloading administrative processes, such as co-payment collection, clinical documentation, and pre-population of common clinical orders.
For patients not as familiar with digital interactions and the variety of telemedicine modalities, which can include platforms like Amwell, Doctor on Demand, and Teladoc or video conference solutions like RingCentral and Zoom, participating in virtual visits can be a daunting change. Additional technological challenges associated with virtual care can result in heightened frustration, increased no-show rates, or decreased activation, so maintaining patient engagement throughout the patient journey is even more important in a virtual environment. Digital medical assistants can automate appointment reminders, offer detailed setup guidance for patients, and provide “just-in-time” virtual visit links to ensure patients and providers can make the most of their time together.
The COVID-19 pandemic has also introduced new variables and risks that patients, providers, and healthcare institutions at-large must consider when seeking and delivering care. Until recently, it was a relatively straightforward process to determine where a patient should receive routine care. Now given the risk of disease spread, providers find themselves considering which patients to see when to see them and whether to see them virtually or in-person.
This creates additional complexity in determining when to schedule patients and in which medium to conduct the visit. Platforms that leverage intelligent automation can help clinical teams to pre-screen all scheduled patients, collect a thorough medical history, intelligently segment patients into risk cohorts and triage each cohort to an individualized destination, be it a return to in-person care or a virtual environment.
In the “virtual exam room,” things also look a little different. From the provider’s perspective, one of the oft-cited drawbacks of virtual visits is the limited ability to measure vital signs, perform a physical exam or order point-of-care diagnostics. At-home diagnostics, wearable devices and remote patient monitoring tools allow providers to collect continuous clinical data that can be gathered asynchronously and quickly, resulting in a more comprehensive picture of a patient’s health. Further, platforms that use intelligent automation algorithms to organize data collected across the care continuum can parse these data streams to identify at-risk patients and then automate outreach and care management to follow clinical care pathways.
The COVID-19 pandemic has given us a unique opportunity to reimagine healthcare using a modern suite of technology for patients, providers and staff that does away with outdated and inefficient processes. But we also have a responsibility to replace them with solutions that improve digital experiences by supporting patients before visits, automating repetitive workflows, and parsing large amounts of data to support clinical decision-making.
Combining intelligent automation with virtual visits creates a powerful tool to efficiently manage patient populations and offer an experience that feels intuitive while enabling healthcare systems to do more with less. By accelerating the digital transformation of healthcare today, we can position ourselves for a future of increased capacity, decreased overhead, and improved quality.
Muthu Alagappan, MD, is an attending physician at Massachusetts General Hospital, a trained engineer, and medical director at Notable Health, a healthcare experience automation company.
– Boston-based health IT start-up Cohere Health announced the official launch of its company with a $10 million Series A funding round led by Flare Capital Partners.
– The company’s patient journey-focused platform improves the notoriously difficult prior authorization process and replaces an existing patchwork of legacy, siloed processes, and antiquated technologies that contribute to the enormous administrative burden for physicians and health plans.
– The end goal is transparent, high-value care alignment across the entire patient care journey, to improve the quality of care delivered, the lower total cost of care, and transform the patient and physician experience.
Cohere Health, a
Boston, MA-based health
today announced its company launch, with the mission of aligning the
relationship between physicians and health plans around the care journey in a
way that is appropriate for each patient. Cohere Health’s launch is
flanked by the news of its recent $10 million Series A funding round led by Flare Capital Partners, with Define Ventures as an investor and partner
as well as participation from an additional leading national strategic partner.
Every Health Journey Should Be A Win-Win-Win
Confusion and complexity shouldn’t define a patient’s journey. Patients deserve clearer paths to health, more transparency, and fewer bumps on the way. Assessing every transaction without any context creates an undue burden for physicians and health plans alike. Administrative complexity should never stand in the way of patient care.
Led by Co-Founder and CEO Siva Namasivayam, Cohere Health aims to improve the quality of care delivered, the lower total cost of care, and transform the patient and physician experience. Cohere’s patient journey platform, CohereNext replaces the existing patchwork of legacy, siloed processes, and antiquated technologies that contribute to enormous administrative burden for physicians and health plans. It further facilitates the transition from fee-based services to value-based arrangements by providing an evolutionary path that can support all payment arrangements while reducing unnecessary variation in clinical outcomes.
Benefits of Care Journey Recommendations
Cohere leverages care journey recommendations to fundamentally change the healthcare system through:
– Evidence-based care paths: increase transparency and trust among patients and their physicians.
– Advanced analytics and rules: help identify high-value care and, ultimately, improved outcomes
– Payments and incentives: incentivize physicians by ensuring that behavior leading to optimal patient outcomes also benefits practice economics
Proven Leadership Team
Cohere Health has assembled an impressive team of proven
leaders, including Gary Gottlieb, MD, former CEO of Partners Healthcare (now
MassGeneral Brigham) as Chairperson of the Board of Directors. “As a physician,
it’s clear to me that the administrative complexity of the current system gets
in the way of delivering the care that patients deserve, that physicians want
to provide, and that health plans want for their members,” Gottlieb said. “If
we’re going to realize the promise of value-based care, we need an approach
that is based on all available evidence, shared expectations and transparency.”
Siva Namasivayam, CEO of Cohere Health, explained: “The current system is resource-intensive, unwieldy and creates a frustrating experience for patients, physicians and health plans. There’s no reason it should be so miserable for everyone involved. We have the evidence-based clinical algorithms, human-centered design and innovative technology to improve the system dramatically.” Namasivayam, who has more than 20 years of experience working on transformational healthcare businesses, was previously the CEO/Founder of SCIO Health Analytics.